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| Music as Therapy: A Case Stuy
Hello all,
I have enclosed in this message a qualatative case study that I had
written for one of my doctoral projects: "Creative Music Therapy
with a Boy with Multiple Impairments:Stepping out of isolation into
new experiences."
The story gives a glimpse into the process of how active music
making, with clinical intent, can be used as a tool to reach
children and help make them active partners in their own therapeutic
process. If you have the time, please check it out. All the best,
John C
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Creative Music Therapy with a Boy with Multiple Impairments:
Stepping out of isolation into new experiences.
John A.Carpente, MA, NRMT, CMT – The Rebecca Center for Music
Therapy
Abstract
This case study describes how a seven year old boy developed
openness to relationship, verbal skills, increased awareness,
spontaneous _expression, and an increased level of focus through 20
sessions of Creative Music Therapy. Creative Music Therapy is a form
of individual therapy in which therapist and client improvise music
together. The sessions lasted from September through June 2002.
Through clinical improvisation within musical structures, and pre-
composed adapted songs, Mikey gained the ability to form a musical
and interpersonal relationship that led towards an exploration of
alternate ways of "being" in the world. His process will
illustrate
how musical experiences helped guide him out of isolation and into a
musical world of interaction—working through issues such as fear,
intimacy, conflict, and resolution.
History
Mikey is a seven year old boy diagnosed with Autism, Down syndrome,
Attention deficit disorder, a communication disorder and a behavior
disorder. In addition, Mikey is intellectually impaired, non-verbal
(Apraxia), has a moderate hearing loss in his left ear and is
diagnosed with XYY syndrome. Mikey is currently on the following
medication: seroquel, dexedrone, nasonex, flovent, and synroid.
Mikey is enrolled in a five day per week school program where he
receives speech, occupational, and physical therapy. He lives with
both of his parents on Long Island, New York. His father is a
computer programmer, and his mother is a community health nurse. He
has one sister who is 12 years old at the time of this study.
Assessment
Interview with Mother
According to his mother, Mikey can be very charming, but can get
easily agitated and aggressive at times as well. At home he will
interact with his sister and parents. At school he is in a small
class and will not interact with other children. He can get agitated
in large, noisy situations and will work in a corner of a room to
hide in, when feeling uncomfortable. His attention span and level of
focus is very limited, and although he learns through repetition he
gets easily distracted.
His mother would like to seem him develop an enjoyment for music,
have fun, and find an outlet for his aggression. Mikey will listen
to music at home, however according his mom, "loves The
Ramones."
(The Ramones were a 1970's American, punk rock band.)
Clinical Assessment
The clinical assessment took place through the course of five
sessions. After five sessions I felt that I had an accurate
"sense"
of Mikey, and began to formulate a goal plan.
For each of the five sessions I had a variety of instruments for
Mikey to choose from including hand drums, a xylimba, a guitar,
horns, and a tambourine that I kept along side of the piano. I had
placed a drum and cymbal in the center of the room.
My in-session observations focused on the following:
1) How did Mikey separate from his mom?
2) How did Mikey's mom separate from him?
3) How did he adapt to this new environment?
4) His musical choices (instruments chosen, length of time with
particular instruments, and initiating decisions)
5) His musical responsiveness (Did he respond to me or my
music? Was is his music related? What was the musical quality of his
playing?
The findings of my assessment of Mikey are based on viewing each
session on videotape, writing a moment to moment log while viewing
(index sheet), writing a synopsis of each session, and logging my
personal reactions and reflections as to what my clinical rationale
and intent had been.
After reviewing the videotaped sessions, and the index sheets of our
first 5 sessions, I saw that each session had been almost identical
in how Mikey reacted and responded to the new environment,
physically, emotionally and musically. Session 5 is presented here
as typical of these assessment sessions, which I termed, "Trying
to
find hello, behind the wall of drums."
Summary of Session Five
As I begin playing our 4-week old greeting song, with the door wide
open, waiting for Mikey to enter the room, I can hear him struggling
with his mom. I stop playing and proceed to assist her in getting
him into the room. As she picks him up and quickly runs him into the
room, places him down and runs out before he can follow out her, he
displays his struggling and frustration through wild kicking and
grimacing facial expressions, however, he never utters a vocal
sound. After the door closes, and he realizes that he cannot get
out, he lies on his back and begins kicking the door frantically
with the soles of his feet, making no vocal sounds. As this behavior
continues, I begin to improvise on the piano within the structure of
the greeting song that had evolved to date. Through the music, in D
major, I try to make Mikey's kicking communicative and thus more
integrated into the music. I do this by matching his rhythm,
dynamics, and intensity, while introducing him to music time,
singing "hello, hello, hello," in ascending intervals of a
third,
fourth, and a fifth based on D major. (Because the voice can be
intimate and intimidating for a child with no language in a new
environment, I sang intermittently using just the word
"hello"). As
Mikey continues to kick the door, he displays no obvious awareness
of me, or the music that I am playing.
As his kicking tantrum subsides, he briefly wedges himself in a
corner between the door and the wall with a look of what appears to
be fear and anxiety. He then crawls to three separate drums and
drags each of them to the corner. He is constructing what seems to
be a barricade. He is now sitting between the three drums (snare
drum, a mid-size floor drum, and a floor tom) and the corner by the
door. With his back resting on the door, as he is seated on the
floor, the drums seem to tower over him. I am barely able to see
him, as I am seated at the piano watching him construct this wall,
deciding not to physically move into his space.
Staring at the mid-size floor drum, he begins to play one drum with
both of his hands, his arms pointed straight out without any
flexibility in his elbow. As he plays the drums, above his head, I
attempt to support his playing, trying to find his tempo. He has
difficulty playing a steady beat. I try to ground him musically,
providing a steady quarter note bass ositinato, playing between a D
minor chord and an E diminished chord while improvising a melody
with my right hand. (I made a conscious decision not to use my
voice, feeling that it would be too overwhelming, based on how he
presented). The melody I am improvising is based in D minor and D
Dorian, emphasizing the B and Bb.
At times our music meets for brief moments, followed by Mikey
playing faster or in a disorganized way. Throughout this interaction
he displays minimal eye contact.
For the duration of the session, Mikey remains barricaded behind
the "wall of drums." Moving into our good bye song, I decide
to use
the guitar and place myself physically closer to him. I begin
strumming the chords lightly, singing "It's time to say
------,"
seeking verbal closure. Mikey does not respond in any way. I
complete the lyrical phrase, "good-bye," and I repeat it.
This time
I choose to hold the guitar in front him, looking for him to
complete the musical phrase by strumming the guitar, he does not
respond. I gently try to hold his hand and brush the strings with
his right hand; he pulls his hand from mine. I complete the song,
and repeat it once again. The song ends, and I say "Good-bye
Mikey,
thank you for your music." He gets up and turns to the door, as
he
impatiently waits for me to open the door. He runs out into his
mother's hands and begins pulling her to leave.
Assessment results
Mikey appeared to have a difficult time separating from his mom.
However, his mom seemed willing to do what was necessary to get him
into the therapy room. My feeling is that this is something that is
she accustomed to doing.
When Mikey would finally get into the room, he had a difficult time
adapting to this new environment. In each of the five sessions,
every time our music made a moment of connection, he played faster
or stopped playing. This type of interaction displayed Mikey's
awareness to his environment and to my music, as he chose to "cut-
off" musical contact by playing faster, or by stopping. His
choice
to change his music is a direct response to my music trying entering
into his.
Vocally, he has yet to make any sounds during our sessions. I found
it interesting that, although his mom stated that he can vocalize,
he has never made a vocal sound when struggling with his mom before
entering the room. I feel that he has made a choice to hide his
voice from me, and wonder whether this may show his ability to be
self-conscious. If so, how does he perceive his voice? And how does
he perceive the way the world perceives his voice?
Planning the Treatment Process
Goals
The following goals emerged from the assessment following session 5:
1) Mikey will begin to feel safe in music therapy.
2) Mikey will begin to leave his "comfort zone" behind the
wall
of drums.
3) Mikey will begin to use his voice in any way during music.
4) Mikey To begin to explore other instruments besides drums.
5) Mikey will begin to sustain musical contact for 30 seconds.
6) Mikey will begin to play musically and inter-related fashion.
Self-Evaluation: Why am I playing what I'm playing?
After watching the video and documenting our fifth session, I began
to ask myself, why am I playing what I am playing, specifically
during our greeting song? It appeared to me that I was greeting him
with music based on how I wanted him to respond. In other words, my
music did not appear to be taking into consideration who he
was—his
personality, his emotionality, and his capability to respond. While
the greeting song rhythmically and dynamically may have mirrored the
quality of his trantruming, it also may have been the reason why he
continued to react in that manner. I began to realize that the tempo
of my music had been "fixed," it lacked mobility. The melody
appeared to be extremely legato, leaving no musical space between
each melody note. In addition, the musical phrases were too long
(according to Mikey's mom, he has an extremely short attention
span.) and were demanding too much of Mikey's attention for an
extended period. In short, the music had been a "wall of
sound," it
became wall paper. It lacked in excitability, unpredictable melodic
leaps, and musical space (harmonically, melodically and
rhythmically).
Realizing that Mikey is an energetic, strong willed boy, I needed to
be conscious of the fact that a battle of the "wills" during
the
early stages would have been counter productive, in that the
sessions would have turned into power struggles that would have
created patterns and structures that would have been difficult to
change in future sessions
In addition, accepting him where he was, both emotionally and
musically, while also creating reasonable limits, could be the core
of the work. The entire process required a balance between the
structured and the unstructured, and between conflict and resolution.
Musically, in preparing for Mikey's session, I reminded
myself that I needed to listen more attentively, be in the musical
moment with him (to create music based on his needs and not my
comfortablity), and respond to him as opposed to reacting to him.
Paul Nordoff (2000) was quoted in "Being in Music" as
stating, "…
preparation for clinical work has a Zen-like quality in which the
therapist becomes cleared of any extrinsic thoughts, ideas, and
feelings which inhibit a deep living in the moment." He continues
by
saying, "The ability to completely be in the moment allows the
creation of clinically potent music and this is the key to effective
therapy (2000, pg. 10)."
Treatment Begins
Breaking down the Barriers
Prior to the start of our 7th session, I decide to prepare the room
for Mikey, creating his "drum wall" for him. At the start of
the
session Mikey enters the room with a struggle, but not with the
intensity as in previous sessions. He appears to notice that the
drums are set up to his liking. He sits down on the floor and begins
to briefly explore each drum with his hand. I do not play anything
at this time, waiting for him to complete his exploration, and free
the room of sound. After he finishes hitting each drum,
approximately 10 seconds later, there is a moment of silence. I am
at the piano, purposely not looking at him, sitting in the silence.
I abruptly play and sing "hello," the melody on the piano
mirrors my
singing voice, singing the "a" ("hel") above middle
"c" and the "g"
("lo") above middle "c." The harmony in the left hand
is based on a
1st inversion D minor7 chord omitting the 5th. I then use an abrupt
silence, and then abruptly sing "Mikey," again the melody on
the
piano mirrors my singing voice, singing an "a,"
("Mi") an octave
above middle "c" and the "g" ("key") one
octave above middle "c." I
repeat this several times, each time changing octaves, tempo, and
dynamics. I notice that when I had extended the rests he looks to
me, waiting for me in anticipation to complete the short phrase. I
then utilized the tambourine, using it to punctuate the end of each
phrase. Before bringing the tambourine to him, I model for him (i.e.
after singing, "hel-----lo!-----Mikey!" ending the phrase by
hitting the tambourine on the first beat of the next measure). After
modeling this several times, I move from the piano each time the
punctuation is about to occur, and bring the tambourine to him.
Mikey plays it in the appropriate space. He does it again, and
again! I then decide to hold the tambourine out, reaching towards
him while remaining seated at the piano. I complete the phrase,
holding the tambourine out, waiting for him to get up and come to me
to punctuate the phrase. I patiently wait, sustaining the 2 note
chord in my left hand (middle "c" and "d" above
middle "c"). He gets
up, walks cautiously towards me, and plays the tambourine at an
arm's length, and goes back to his familiar seat. I play the
phrase
faster with limited silence, hoping he would decide to stand next me
for a sustained period of time. He seems to realize that he is
controlling the music, and remains standing while waiting for his
turn to play the tambourine. He watches nervously, waiting for me to
pass him the tambourine. As the musical give and take continues,
Mikey begins to make short and soft tonal vocal utterances whenever
he would hit the tambourine. This musical exchange lasted for over
5 minutes.
The moment the activity concluded, Mikey reverts back to his
usual spot on the floor behind the drums. I decide to use the
guitar, looking to continue to develop his comfort level with me
physically and musically. I begin to play in the key of A major,
playing very casually with no intent other then to try and find a
musical mood to convey, while physically moving closer to him.
Finally, I get physically close to Mikey, sitting on a child's
size
chair, approximately 2 feet from where Mikey is sitting, playing a I
chord followed by a to V9 chord, each chord being played for 2
beats, in a slow fashion, with no fixed rhythm, changing tempo, and
at times playing the chords in a legato manner or in a detached
fashion. Mikey is watching me, the mid-size floor drum is between
his legs. He begins to play, using the mallets for the first time,
holding both mallets in his left hand, while supporting with the
right hand. He is playing the drum in a rapid manner, appearing to
be trying to play as fast as possible, with no apparent attempt to
be musically connected. However, he watches me as he plays, looking
for approval or acceptance. I begin to mirror and reflect his
playing, adapting the above chord progression to his playing. I try
to organize the rhythmic structure by creating pauses, and over
emphasizing the down beats. During the repeated pauses, Mikey plays
through them, and appears to enjoy this as he clearly hears his
playing with and without me. I then change the placement of the
pauses, and create more tension in the V chord waiting to venture
off into a different musical direction, bringing in my voice and
exploring melody with him. I ornament the V chord, making it into
and V7raised9, creating a build-up to move into the Ramones
song, "Sedated." I begin to play the song, using a I-IV-V
progression in A major; he continues to play the drum in an
excitable fashion. I bring in my voice, singing the melody without
words, using a "raspy" voice style, and singing and playing
with a
lot of energy. Leaving pauses in the song, Mikey fills the pauses
with excitable vocalizations. I get so excited, and continue this,
Mikey again sings through the pauses. The musical dialogue lasted
over 8 minutes.
At the conclusion of the session, I had introduced our good-
bye song, leaving spaces in the music as I did earlier; Mikey does
not respond instrumentally or vocally. He appears to understand that
we are ending as he stares at the door waiting for me to let him
out; however, he makes no effort to want to be a part of our good-
bye song
Evaluation
My decision to prepare the room for Mikey, may have sent him a
message saying, "I am here to help you, if you like the drums set
up
this way, that's fine. If you need me I'm here, and I'll
be waiting
for you" How much of an impact that had on the session, I am not
quite sure. However, what it did achieve was to keep his attention
away from building his "wall," and potentially be more
attentive to
our greeting song.
The usage of tempo mobility, "open" harmonies, short
phrasing, and unpredictable silences attracted his attention, and
persuaded him to play music in a related fashion. It appeared, when
listening back to the session, that the music of the greeting song
had been a reflection of his personality: high energy,
unpredictability, detached and fragmented, suspenseful (anxiety and
unsure), playful, and a longing for connection.
The fragmentation and disconnection of the music called out
for his involvement, providing him with the "job" and
responsibility
of connecting the music and moving it forward. The silences and the
long pauses awaiting his involvement seemed to empower him, as he
realized that he controlled the forward movement and resolution of
the music. Cognitively, through this activity, Mikey displayed his
ability to predict and sequence. He also showed his "want,"
to be
connected in some fashion, as he is begun to trust this new
environment.
My choice to use the guitar following the greeting song was
to maintain and increase physical and musical contact. The guitar,
because of it portability and mechanics can create a greater feeling
of intimacy. Mikey and I had entered into a new "space," and
I felt
that I wanted to widen that "space" by utilizing the guitar
and my
voice. Because we had increased the level of our relationship,
musically and interpersonally, he and I had entered into new
territory. I chose in the moment to bring in music that would be
somewhat familiar (According to his enrollment form) to him: The
Ramones, " Sedated." This intervention created a sense of
security,
by evidence of his smile, and his more intense musical involvement
(vocally and instrumentally). While adapting this song for Mikey, I
kept in mind that he is unable to say words. I chose to sing non-
verbally as way to meet him where he was. His tonal vocalizations
showed were musically related and displayed his sensitivity to
pitches.
Interestingly, during our good-bye song, Mikey chose not to
participate or acknowledge me. However, he did acknowledge the fact
that we were saying good-bye as evidenced by facing the door and
waiting for me to open the door for him. Why did he choose not to
engage during the good-bye? Did the level of intimacy during the
session reach a peak? Was he afraid to say good-bye? Did his lack of
language contribute to his fear? Or, when he was so intensely
engaged, was he so "living in the music" that he experienced
himself
and the world in a new way, transcending him beyond his pathology?
Ken Aigen describes a concept in Nordoff-Robbins Music
Therapy, "living in music," where by the therapist and client
are "living in the music" as completely as possible, and the
client
is able to experience the world beyond his pathology (1996, p. 12).
During this process the client's "entire physical, emotional
and
spiritual being is becoming manifest in the music and the music
functions as an extension of the person" (Aigen, p.12).
Treatment Summary After 12 Sessions
Mikey's responses
Following 12 sessions, Mikey has learned to adapt to the new
environment. He can enter the room willingly, with anticipation and
enthusiasm. He has begun to explore more areas of the music therapy
room, as opposed to confining himself to one area near the door.
He has displayed an increase in comfort with me, and in
communicating what instruments he wants to play through pointing. He
has continued to reject any melodic instruments, such as the reed
horn, xylophone, xylymba, and resonator bells. (My feeling is that,
due to a moderate hearing loss in his left ear, as reported by his
mother, he may have difficultly hearing certain pitched instruments,
and may feel more grounded by the deep sound of the various drums
available to him.)
He has increasingly used his voice (non-verbal singing)
during music making. He has responded to my mirroring and reflecting
techniques in our musical exchanges by increasing his musical-
relatedness while playing drums and singing. In addition, this
technique has been effective in helping him increase his awareness
and strengthen our client-therapist relationship, musically and
interpersonally; as he has realized the importance of his music and
the role it has played in the musical whole during our interactions;
he is aware that his music matters.
His non-verbal vocalizations through singing are tonal,
communicative, loud, and "grunt-like," with limited
flexibility in
dynamics and range. He has displayed an increased ability to
complete musical phrases, and has appropriately filled in musical
spaces. He continues to have difficulty moving into my music, in
terms of dynamics and tempo. In short, the music has been following
and chasing Mikey, and he decides when he wants the music to catch
him. However, Mikey doesn't seem to either want to, or know how
to
chase the music and insert himself in it.
His drumming has become increasingly related to my music for
brief moments. Sustaining musical contact on the drum continues to
be difficult for him, as evidenced by him playing faster or stopping
to play at times when musical contact is established.
Session Form
The sessions have begun to take form, as I imposed the importance of
completing songs and improvisations, rather then just moving
aimlessly from music to music. This has been extremely challenging,
completing activities while, what seems to be, me always chasing
Mikey musically. I worked on structuring the sessions by using
clinical songs as separate entities, each containing their own
identities and structures, but together make up a session. Each
clinical song contain layers of different forms of musical
_expression and experiences being offered to Mikey. Each of the
clinical songs, although structured in its harmonic composition,
contained improvisation within their chordal structures. I would
change tempo, use variations in the melodies, and rearrange the
harmony depending on Mikey's responses. The sessions are
structured
as: 1) "Hello" 2) Improvisation 3) "Sedated" 4)
Improvisation or an
adapted version of a pre-composed activity song 5) "Good-Bye"
The Next Phase of Treatment
Updated Goals after 12 Sessions
After 12 sessions the following goals have emerged:
1) Mikey will continue to utilize his voice in a communicative
fashion
2) Mikey will begin to increase the dynamic range of his voice
3) Mikey will sustain musical contact, beating a basic beat for
the duration of 1 song
Musical Intimacy vs. Destruction: Resistiveness
Ten minutes into our 13th session, Mikey chooses to play a reed horn
(B) during an improvisation based in F Lydian in ¾ time, in which
I
am playing the guitar. The harmony is based on 3 chords: F/A (3rd,
5th, Root), Dmin6/B (6th, 3rd, Root), and Cadd6 (Root, 5th, 6th).
Mikey begins playing the horn, for the first time, by blowing softly
and cautiously. I am simultaneously playing the guitar and a reed
horn (F) to model, and attempt to create a dialogue between both
horns. Mikey's horn playing begins to get louder and confident.
As
he randomly blows, the music is attempting to surround his tone,
and "make" his "B" fit into the harmony of the Dmin6
chord. I begin
singing to try to organize his blowing: "You can
blow"-----"Your
horn!"----. My vocal line begins on the first beat, each word
gets 1
beat: F ("you"), G ("can"), A ("blow"). Mikey
responds by blowing on
first beat of the next measure. After repeating this sequence 6
times, I chose to remove my voice. The interaction continues as
Mikey blows his horn in the appropriate spaces in the music. I then
leave the familiar sequence, changing the tonality to G major;
basing the harmony between the I and V chords: G major 9 (Root
position) and D 13. Mikey changes the quality and placement of his
horn blowing, blowing initially on each beat, in a staccato fashion.
I begin to slow the tempo; Mikey's blowing slows down as he
continues to blow "on the beat." I then bring my singing
voice back
singing, "That's Mikey!" That's Mikey, blowing his
horn!" Shortly
following this, Mikey begins to bang the floor with the horn and
then throws it up in the air. He then runs to the drum, and
intentionally knocks it over. He runs to the cymbal, tries to knock
it over, but I get there in time to hold it up. He runs to his chair
and knocks it over. I decide to remove the instruments out of his
vicinity and group them all together next to the side of the piano
where I can "stand guard." He then points to the door,
signaling
that he wants to leave. The session is nearing its end, but I
didn't
want to end without singing good-bye. I express to him," We have
to
sing our good-bye song first." He proceeds to go to the door and
stand in front of it. I sing good bye to him, and the session ends.
Evaluation
Mikey's level of trust in me and the new environment continues to
increase, as evidence by the intimate musical exchange that occurred
during the "horn/Lydian" improvisation. The use of Lydian
created
intrigue and tension through the chosen harmony combined with
Mikey's horn (B). Mikey's tone, which truly
"brought" out the idiom
(This particular Lydian improvisation is based on F major, lowering
the 4th degree of the scale, in this case changing Bb to
B), "placing" his tone in the "spot" light before
resolving the
harmony to a Cadd 6 (The B resolves to A, the 6th in the C chord;
and the A remains for the F chord). The use of ¾ time appeared to
create a sense of urgency leading into each measure, while also
shortening each phrase, as opposed to 4/4 time. The ¾ time also
created the effect of the music "running away," and that
Mikey's
music would need to "work" in order to catch the music.
The change in tonality, Lydian to G major, was intended to
give Mikey a new experience based in diatonic harmony; deepening his
musical involvement and creating more "flow" and less
harmonic
tensions.
The intimate musical experience of the "horn" improvisation
may have provoked his destructive behavior. This form of defense,
after a heightened level of intimate musical contact, is a concept
that Nordoff & Robbins have coined as resistivenss. Nordoff and
Robbins (1977, p.182) discuss how resistive behavior is a natural
occurrence in therapy related to the relationship between the child
and therapist; in which the child is reluctant to participate and
respond to the music.
Not all response in therapy is participatory: with autistic, post
autistic, or other emotionally disturbed clients, resistiveness
appears in many forms to impede, and in effect influence the
development of relationship. With many clients, resistiveness is a
corollary to participation-a progressive response is generally
preceded and/or followed by one that is resistive in some way."
(Nordoff & Robbins, pg.182)
According to Bruscia (1987), resistiveness is the child's
need to integrate the experience of increased intimacy brought on by
shared musical peak experiences. (p, 62-63).
Negotiation: Choosing to "Music" over Isolation
Session 16 had been the 4th consecutive session that Mikey had shown
destructive behaviors following sustained musical contact; throwing
drum sticks and knocking over drums. However, in session 15 he
introduced a new behavior following his outburst: he laid himself on
the floor, lying on his stomach, faced down and wedged himself
between the floor and wall nodding his head "no" when I would
ask
him to pick up the drum sticks)
In session 15, the pattern continues, as he knocks over 2
small chairs and throws the sticks across the room. Following this
behavior, I begin to improvise music on the guitar playing in 3rds,
5ths and octaves going into and out of diatonic harmony, whole tone
and a pentatonic idiom in a gentle and slow fashion. The music is
not directed towards him. The music shifts its attention to
just "me." I purposely do not look at Mikey, but I can I see
his
reflection on the piano. He looks up and seems puzzled that I have
no reaction to his outburst, and my music is not reaching for him.
He seems to be intrigued or caught off guard. I begin to sing in a
gentle, falsetto voice as the music begins to form itself. Mikey
begins to vocalize in his familiar way, grunting tonally and loudly,
attempting to re-direct the music to him. Mikey sings louder, trying
to get the attention of me and the music. I initially give the
impression that I am ignoring him. I finally look to him while
singing and playing, and I begin to sing, "pick up the
sticks" "Oh
pick up the sticks." I play the melodic rhythm on the guitar,
using
detached strumming to mirror and emphasize each word. Mikey slowly
walks to the sticks, picks them up and hands them to me one at a
time. The music continues as I sing "thank you, what a good
boy." I
repeat the phase, "Thank you what a good---- (leaving the word
"boy"
out for Mikey to fill), Mikey fills in the space with a vocalization
while jumping once on that beat. I then change the lyrics and
sing, "Now…you have to pick up the chairs, pick up the
chairs, you
have to pick up the chairs before we say good-bye." The music
never
reaches resolution until all of the articles are picked up. (Rather
then going to the I chord at the turn around, the music eludes to
resolve by going to alternate/substitution chords, such as vi7, iv7,
iii, and bIII). Mikey picks up each chair, one at a time. After
completing this task, as the music continues, he walks over to me
and lays his cheek on my shoulder, and I complete the song
singing "thank you." Preparing to sing good-bye Mikey runs to
his
chair, and taps the chair next to his, signaling for me to come sit
with him.
Evaluation
During Mikey's resisitveness in session 16 he showed several new
aspects of himself: 1) he showed a new sense of himself and an
awareness of me, as he realized that the music and I were avoiding
him 2) he showed how much he likes to be a part of the music, when
he began to sing louder trying to draw the music to him 3) he showed
that he enjoys "being heard." 4) he displayed affection
towards me
as he laid his cheek on my shoulder, and later invited me to sit
next to him. 5) he understood me when I sang "pick up the sticks
and
chairs".
I felt that Mikey needed to take responsibility for his
actions in picking up what he had knocked over. Instead of battling
him and making him do it, I gave him a choice, either 1) pickup the
instruments if you want to be a part of the music or 2) do not pick
up the instruments and choose to keep yourself isolated from the
music. Mikey's choice to join the music and to be a part of
something bigger then himself, shows his new sense of
"being;"
someone who wants to share his world and be a part of someone
else's
world, as opposed to remain in the "comfort" of his own
isolation.
Mikey missed the next 2 weeks of therapy due to illness.
The Birth of a New Voice: "Let's Sing a
Song" & nbsp; & nbsp; & nbsp;
Seventeen minutes into our 20th session, Mikey and I are both seated
on the floor facing each other as I play a pre-composed song,
entitled "Let's Sing a Song." (Ritholz & Robbins, 1999,
p. 44). It
had been part of our clinical repertoire for several weeks, with
Mikey typically completing the musical phrases with tonal grunts.)
As I play the A section of the song, Mikey listens to me singing and
playing, I improvise a new B section (as I usually did in previous
sessions), to add anticipation of the A section. As the B sections
comes to an end, before moving into the A section, I slow down the
music vamping on a diminished chord in several inversions for 2
measures to create additional tension and anticipation. I finally
resolve to the I chord (C), singing, "Lets----, Mikey completes
the
phrase and "takes the song on" himself, singing different
vowels
sounds (e, ah, and o). His singing voice takes on a new life,
expressing itself in a new way; his melodic lines are connected
(legato), tonal, and extremely thoughtful and sensitive to the music
being played. Watching him sing, I see the amount of energy it is
taking for this little boy to get these sounds out of his body. It
seems as though he is squeezing the sounds out of himself, closing
his eyes and cringing his face. I am trying to move him along in the
song, by creating tensions with his struggle, trying to
"time" the
music's resolution to his vocalizations, strumming and sustaining
chords, waiting for him to lead the music into the next note.
Following this activity, I begin to sing and play our good-
bye song using the same musical interventions used in "Let's
Sing a
Song." Hoping for the same results, I incorporate additional
tensions in the song, playing inversions and open harmony chords
(placing 3rds and 5ths in the bass): C/G, G/B, C/E, C/G, G/B, Gmin7,
C9/G, F/A, F#dim, C/G, etc. I sing, "It's time to say----,
and Mikey
miraculously sings "bah, bah." I repeat this leaving space
for the
word "bye," Mikey again completes the phrase, singing
"bah, bah" and
flapping his hand up and down. The music moves into the B section
(F/C, F#dim, C/G, Amin7, D9/A, G#dim7, C/E) in which I address both
of our names. (The music in the B section is similar to a gospel
type of style due to the chromatic bass line. I sing,
"Good---,"
Mikey sings "bah," I sing "To Mikey," he points to
himself and
sings "bah, bah" on his own initiative; I then sing
"Good-bye to---
," referring to me. Mikey grunts a sound and then uses his
pointer
finger to tap my chest, as he expresses good bye.
Evaluation
During session 20, Mikey asserts his "will" in that he
expressed and
experienced himself in new ways, utilizing, and manipulating his
voice to be a part of the music. This "leap" into a new way
of being
continued to display an increase of his sense of self and others,
musically and interpersonally. In addition, during this session
Mikey displayed his ability to make decisions that allowed him to
accept and integrate new experiences. Mikey's struggle in trying
to
connect the internal (his internal music) to the external (our
music) had been facilitated and supported by and through the music,
as it waited for him, and recognized and reflected his struggles and
ambivalence in harmonic, dynamic and rhythmic structures.
Mikey's intent to sing, physically touch me, and wave to me
as he expressed good-bye displayed his appreciation and integration
of the new relationships being formed interpersonally and in and
through music. In addition, his realization that "we" (the
music and
I) were there for him, accepted him, and waited for him manifested
itself through his increased level of trust and acceptance of me and
my music.
Discussion and Conclusions
Creative music therapy proved to be an effective approach for Mikey.
In the music, a safe and playful environment had been created for
him to explore and encounter musical experiences that lead to his
developments, musically, interpersonally and developmentally.
For Mikey, the music provided a vehicle of communication
that would allow him the opportunity to be "heard," and
understood.
In addition, it created a place where his "voice" mattered
and
played an important role in the music, empowering him and providing
him with an opportunity to be a part of something larger then
himself. In being a part of a larger whole, Mikey's
self-awareness
and consciousness expanded allowing for him to experience new ways
of being.
At a Rebecca Center for Music Therapy fundraiser in May
2003, Mikey's mother prepared this testimonial:
"… His father and I were always looking for a key to tap into
Mikey's abilities. And with music therapy, I think we found a way
to
approach my son's abilities. It is actually one of the few
therapies that we think reaches Mikey. He started working with John
last September. Mikey recognizes John and plays musical games with
him. That is a big step since he does not acknowledge many people.
The naked eye may not see any changes in Mikey, but his Dad and I
do. Instead of spinning around in circles, he actually dances to
music. And just the other day, he took a can and played with it as
a drum. It was so typical, just like other kids. All I could do
was cry because instead of seeing a temper tantrum or a bizarre play
skill, I saw a typical kid...my typical kid.
Music therapy is one of the things that create an equal playing
field for Mikey, and for that I am very grateful."
It is has been a pleasure and a privilege to work with Mikey.
Experiencing his growth has been a true gift, and a constant
reminder as to why I became a music therapist. Personally, he has
taught me how to listen more carefully, to trust the music, and to
be more aware of whose needs I am meeting in each musical moment. He
has helped me grow as a musician and as a therapist, and I look
forward to our future work together.
Glossary
Autism- Autism is characterized by impaired social interaction,
problems with verbal and nonverbal communication, and unusual,
repetitive, or severely limited activities and interests.
Apraxia - Apraxia of Speech is considered a motor speech disorder.
Children with apraxia have great difficulty planning and producing
the precise, highly refined and specific series of movements of the
tongue, lips, jaw and palate that are necessary for intelligible
speech.
Dexedrine - This medicine is used to treat attention deficit
disorders.
Down syndrome - Down Syndrome is a defect of the chromosomes leading
to a characteristic set of abnormalities including delayed
development.
Flovent – Flovent is an inhaled steroid that prevents asthma
attacks
Mirroring (Paul, 2002)
Nasonex - Nasonex is a nasal allergy spray that helps relieve an
itchy, runny nose; sneezing; and congestion
Seroquel – Seroquel is used for the treatment of schizophrenia,
acute manic episodes associated with bipolar I disorder, and
obsessive compulsive disorders.
XYY syndrome - Some children with XYY are developmentally delayed,
but XYY is less common among the delayed population than in the
general population. Children with XYY can have low, normal, or above
normal intelligence. The extra helping of maleness does seem to have
some effect on intelligence, though. These boys tend to score about
10 to 15 points lower than their siblings on standardized IQ tests
(Paul, 2002).
References
Aigen, K. (1996). Being in music: Foundations of Nordoff-Robbins
Music Therapy. St. Louis, Missouri: MMB Music, Inc.
Bruscia, K. (1987). Improvisational models of music therapy. Spring-
field, Illinois: Charles C. Thomas Publishers.
Nordoff, P. & Robbins, C. (1977). Creative music therapy. New York:
John Day.
Paul, Michel (2002, September). Personal Communication.
Ritholz, M & Robbins, C. (1999). Themes for Therapy from the Nordoff-
Robbins Center for Music Therapy at New York University. New York:
Carl Fischer.
FOR MORE INFORMATION ON MUSIC THERAPY AND THE REBECCA CTR FOR MUSIC THERAPY VISIT WWW.THEREBECCACENTER.ORG OR EMAIL JCARPENTE@EROLS.COM |
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